Zero-Dose Knowledge Summaries and Advocacy Briefs

As part of Gavi 5.1’s ambitious agenda to end backsliding in routine immunization and commitment to the Sustainable Development Goals (SDGs) vision to “leave no one behind”, Gavi, the Vaccine Alliance, has commissioned IVAC to produce a series of evidence-based Knowledge Summaries and Advocacy Briefs to inform policy and advocacy work to increase equitable immunization access for all. These documents focus on zero-dose children—those who have not received even the most basic vaccines—and their relevance in wider global policy agendas, including humanitarian crises, gender equity, universal health coverage, resilience, and health economics.

The Knowledge Summaries below present a snapshot of the available scientific evidence on zero-dose children within these policy contexts and highlight key findings from the latest peer-reviewed literature. The accompanying Advocacy Briefs build on this scientific knowledge to present evidence-based policy recommendations to prioritize and reach zero-dose children. The related webinars give voice to global and national practitioners to share their experiences and best practices in multi-sectoral approaches.

  1. Zero-Dose Indicators and Measurement
  2. Zero-Dose in the Context of Humanitarian or Conflict Settings
  3. The Role of Gender in Addressing Zero-Dose and Immunization Equity
  4. Strengthening Immunization Equity through Primary Health Care
  5. Building Health Resilience in Zero-Dose Communities
  6. Economics and Value of Immunizing Zero-Dose Children
  7. Webinars

Zero-Dose Indicators and Measurement

This Knowledge Summary examines data on zero-dose children including estimates of current levels, trends, factors associated with a higher risk of zero-dose status, and the approaches used to identify these children.


Zero-Dose in the Context of Humanitarian or Conflict Settings

Approximately 1 in 5 zero-dose children in Gavi-supported countries live in humanitarian or conflict settings, and evidence demonstrates that the fragility of these settings can negatively impact immunization rates. These papers examine the barriers that zero-dose children face in accessing health care and immunization services in conflict-affected settings, how these fragile settings exacerbate existing challenges, and strategies to improve immunization equity in this context.

Knowledge Summary


Advocacy Brief: Equity in Crisis


The Role of Gender in Addressing Zero-Dose and Immunization Equity

Gender-related barriers underpin inequality in immunization and can stand in the way of improving immunization coverage. These obstacles may be particularly prevalent in settings with high rates of zero-dose children. As such, gender-related barriers must be accounted for throughout the entire vaccine distribution process. These papers explain how gender equity impacts immunization coverage and highlight the importance of gender-responsive immunization interventions to overcome these challenges.

Knowledge Summary


Advocacy Brief: Addressing Gender Inequities to Improve Immunization Coverage

Strengthening Immunization Equity through Primary Health Care

Primary health care (PHC) aims to provide accessible, affordable care to all, making it an important lever for advancing health equity. Routine immunization brings children into contact with health services many times throughout a child’s life and also provides an opportunity to build out service delivery infrastructure, supply chain, data systems, and community engagement. These papers explore how prioritizing efforts to reach zero-dose children with routine immunization can be leveraged to co-deliver other PHC services, laying the foundation for achieving universal health coverage.

Knowledge Summary



Advocacy Brief: Primary Health Care and Immunization Coverage for Zero-Dose Children

Building Health Resilience in Zero-Dose Communities

The COVID-19 pandemic has shown that governments across the world need to focus on boosting the resilience of their populations and health systems against shocks and emergencies. Building health resilience at the individual, community, and system level is critical to help the most vulnerable, marginalized communities—including zero-dose children—prepare for and withstand health shocks. Every time routine immunization services reach zero-dose children, their parents and communities get access to stronger primary health care, and these encounters help build resilient health systems by enabling early detection and effective response toward health threats. These papers discuss how to leverage the intersectionality of routine immunization and the zero-dose approach for integrated health service delivery to strengthen health resilience at individual, community, and health systems levels.

Knowledge Summary

Advocacy Brief

The Economics and Value of Immunizing Zero-Dose Children

In an increasingly resource-constrained world, it is critical to leverage health interventions that can cost-effectively and sustainably co-deliver primary health care (PHC) services in vulnerable, marginalized communities, which are often left behind. These papers outline the economic case of immunizing zero-dose children, including how immunization protects these children and their families from catastrophic treatment costs, addresses existing socioeconomic inequities in immunization coverage, and contributes to long-term economic benefits by helping to improve educational attainment and thus potentially increasing future earning potential.

Knowledge Summary

Advocacy Brief


In addition to the resources above, Gavi and IVAC convened global health partners for public webinars focusing on immunization equity and key topics related to zero-dose children. The first webinar featured humanitarian and immunization experts to address the importance of immunization equity in humanitarian or conflict settings, and the second webinar focused on the path toward the Sustainable Development Goals (SDGs) and what Gavi and partners are doing to reach the most marginalized children and these hard-to-reach communities.

Reaching Zero-Dose Children and Supporting Immunization Equity in Humanitarian Contexts


Achieving the Sustainable Development Goals – Reaching the Communities Left Furthest Behind